• pharmacokinetics
• pharmacodynamics
• multiple diseases
• multiple drug therapies

• decrease renal function
  • decrease GFR
  • decrease RBF
• CV effects
  • decrease perfusion
  • decrease baroR control
  • decrease renin activity
  • decrease Ald production
  • increase LV wall thickenss
  • decrease EDRF (endothelial derived relaxing factor aka NO)

• most receptor numbers and/or binding decrease with age
  • drug effects dependent on those receptors vary

• increase fat content
  • increase volume of distribution (Vd) for fat soluble drugs
• decrease water retention
  • decrease volume of distribution for water soluble drugs

• pharmacokinetic changes make it difficult to study
• doses of most CNS depressant drugs need to be decreased in elderly
  • ex: diazepam metabolism shows few changes in metabolism, but respond to lower plasma with age

• unlike CNS depressants, you need to increase drug due to decreased receptor affinity for drug

• decrease in elimination (either met. or excretion), so longer half life
  • less drug needed
• resulting alterations in half life necessitates change in dose

• oral- most peopole, no change
  • however, decrease function with atrophic gastritis
• transdermal- reduced absorption for hydrophilic drugs

• usually reduced
  • decrease liver size and blood flow
  • p450 enzymes are decreased more than conjugation reaction
  • CYP3A4 not affected much
• drugs that undergo extensive first pass effects or high liver extraction
  • decrease blood flow
  • decrease liver enzymes
  • result- higher systemic levels of blood

• conjugation unaffected
• cyp half life increases
• renal half life increases

C = [(140-age)(wt)]/[(72)(serum creatinine conc)]

For females, multiply by 0.85

• adverse reactions increase with age
• if adjusted on per drug administration, it is stable
  • polypharmacy undergooing
  • old peole use more medication and do have greater vulnerability to side effects

• evaluate need for therapy
• careful history including drugs, herbal, vitamins, over the counter
• know pharmacology of drug
• begin therapy in smaller doses
• titrate drug dosage to patient response
• simplifly therapeutic regimen
• regularly review plan and discontinue drugs no longer needed
• always be suspicious

• death
• malformation
• growth retardation
• behavioral changes

Can affect development of specific organs within the body

critical periods (species differ in susceptibility to teratorgens)

• placenta was not a barrier
• fetus is at risk for any drug exposure
• interference with process other than just structural damage is possible
  • can occur later in life
• behavioral effects may not appear until much later

• antipxychotics and antianxiety agents
• antineoplastic agents
• hormones
• drugs of abuse
• retinoids
• alcohol (FAS)
• antibiotics
• anticonvulsants
• ACE inhibitors (in second, third trimesters)

• FAS
  • heart problems
  • growth deficiency
  • mental retardation

• tetracycline
  • decrease bone growth
  • discoloration of teeth
• TB drugs
  • hearing problems

• mental retardation
• slow growth

• fetal injury
• fetal death
• renal dysgenesis
• skull ossification defects

• major congenital malformation
  • esp. CNS defects

May also harm health care worker giving them while pregnant

• UT malformations
• growth retardation